Kong Yuhao, Chen Shaoru, Ma Ning, Chen Zekun, Karoli Peter, Niyi John Lapah, Fan Pengyang, Fink Günther, Kwete Xiaoxiao Jiang, Wehrmeister Fernando C, Cheng Feng, Wang Dongqing, Zemene Melkamu Aderajew, Gatimu Samwel Maina, Khan Nuruzzaman, Rahman Ashfikur, Fekadu Lelisa, Shibre Gebretsadik, Rahmartani Lhuri Dwianti, Aheto Justice Moses K, Geldsetzer Pascal, Li Zhihui
Vanke School of Public Health, Tsinghua University, Beijing, China.
National Institute for Medical Research, Dar es salaam, Tanzania.
EClinicalMedicine. 2024 Apr 5;71:102583. doi: 10.1016/j.eclinm.2024.102583. eCollection 2024 May.
Exposure to multiple risk factors is prevalent in low-and middle-income countries (LMICs), challenging one-directional strategies to address preventable under-5 mortality (U5M). This study aims to assess the associations between concurrence of multiple risk factors and U5M in LMICs.
We extracted data from the Demographic and Health Surveys conducted between 2010 and 2021 across 61 LMICs. Our primary outcome was U5M, defined as deaths from birth to 59 months. Binary logistic regression model was applied to ascertain the association between U5M and a total of 20 critical risk factors. Upon identifying the risk factors demonstrating the strongest associations, we investigated the simultaneous presence of multiple risk factors in each individual and assessed their combined effects on U5M with logistic regression models.
Of the 604,372 under-5 children, 18,166 (3.0%) died at the time of the survey. Unsatisfied family planning needs was the strongest risk factor for U5M (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.9-2.1), followed by short birth interval (<18 months; OR: 2.0, 95% CI: 1.9-2.1), small birth size (OR: 2.0, 95% CI: 1.8-2.1), never breastfed or delayed breastfeeding (OR: 2.0, 95% CI: 1.9-2.0), and low maternal education (OR: 1.6, 95% CI: 1.4-1.8). 66.7% (66.6%-66.8%) of the children had 2 or more leading risk factors simultaneously. Simultaneous presence of multiple leading risk factors was significantly associated with elevated risk of U5M and children presenting with all 5 leading risk factors exhibited an exceedingly high risk of U5M (OR: 5.2, 95% CI: 4.3-6.3); a dose-response relationship between the number of risk factors and U5M was also observed-with the increment of numbers of leading risk factors, the U5M showed an increasing trend ( < 0.001).
Exposure to multiple risk factors is very common in LMICs and underscores the necessity of developing multisectoral and integrated approaches to accelerate progress in reducing U5M in line with the SDG 3.2.
This research is funded by Research Fund, Vanke School of Public Health, Tsinghua University.
在低收入和中等收入国家（LMICs），暴露于多种风险因素的情况很普遍，这对解决可预防的5岁以下儿童死亡率（U5M）的单向策略构成了挑战。本研究旨在评估低收入和中等收入国家多种风险因素并发与5岁以下儿童死亡率之间的关联。
我们从2010年至2021年在61个低收入和中等收入国家进行的人口与健康调查中提取数据。我们的主要结局是5岁以下儿童死亡率，定义为出生至59个月的死亡。应用二元逻辑回归模型确定5岁以下儿童死亡率与总共20个关键风险因素之间的关联。在确定显示出最强关联的风险因素后，我们调查了每个个体中多种风险因素的同时存在情况，并使用逻辑回归模型评估它们对5岁以下儿童死亡率的综合影响。
在604,372名5岁以下儿童中，18,166名（3.0%）在调查时死亡。计划生育需求未得到满足是5岁以下儿童死亡率最强的风险因素（优势比[OR]：2.0，95%置信区间[CI]：1.9 - 2.1），其次是生育间隔短（<18个月；OR：2.0，95%CI：1.9 - 2.1）、出生体重小（OR：2.0，95%CI：1.8 - 2.1）、从未母乳喂养或母乳喂养延迟（OR：2.0，95%CI：1.9 - 2.0）以及母亲教育程度低（OR：1.6，95%CI：1.4 - 1.8）。66.7%（66.6% - 66.8%）的儿童同时存在两种或更多主要风险因素。多种主要风险因素的同时存在与5岁以下儿童死亡率升高显著相关，同时存在所有5种主要风险因素的儿童表现出极高的5岁以下儿童死亡率风险（OR：5.2，95%CI：4.3 - 6.3）；还观察到风险因素数量与5岁以下儿童死亡率之间的剂量反应关系——随着主要风险因素数量的增加，5岁以下儿童死亡率呈上升趋势（<0.001）。
在低收入和中等收入国家，暴露于多种风险因素非常普遍，这突出了制定多部门综合方法以根据可持续发展目标3.2加速降低5岁以下儿童死亡率进展的必要性。
本研究由清华大学万科公共卫生与健康学院研究基金资助。
